Authors: Sunny Abdelmageed
Diffuse intrinsic pontine glioma (DIPG) is a particularly aggressive and malignant tumor of the brainstem. Stereotactic biopsy is utilized for obtaining molecular and genetic information for diagnostic and potentially therapeutic purposes. However, there is no consensus on safety of the biopsy, as well as if a biopsy does actually affect survival. By way of literature review, we aimed to characterize the effect of stereotactic biopsy on survival among patients with DIPG and delineate the rate of neurologic complications among patients undergoing a biopsy.Methods: PubMed, Embase, and Scopus were searched. Records were screened by title / abstract and then by full text. Bibliographic, demographic, and outcome data were extracted from studies meeting inclusion criteria.
Of 569 resultant articles, 14 were included. The total number of patients across all studies was 391, of which 384 (98%) underwent biopsy. Of these biopsies, there were 98 (25.5%) complications. Sixty-three complications (64.2% of all complications, 16.4% of all biopsies) were neurological. The most common neurological complication was cranial nerve palsy, seen in 62% of the papers. Cranial nerve VII palsy (63%) was the most common cranial nerve palsy. Hemiparesis (38%) was the second most common neurological complication. Worsening of speech, dysarthria, dysphasia, and dysphagia were common speech complications. Bradycardia, nystagmus, and hydrocephalus were other common complications. Of 373 DIPG patients in 10 papers reporting survival data, 105 (28.2%) died within study follow-up periods. Median overall survival ranged from 9 months to 15.6 months. Progression-free survival ranged from 5.6 to 8.4 months. There was no mortality from biopsy specifically.
Children with DIPG undergoing brainstem biopsy have low rates of neurologic deficits and no excessive morbidity. Characterization of patient-specific, molecular, and genetic factors influencing prognosis will improve risk stratification and catalyze the development of therapeutic strategies.